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MONITORING WELL INSTALLATION RE9�*+ <br /> Date: PONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I I.D. <br /> Completion- Stove pipe/chrisde box (circle one) <br /> Drilling Company: <br /> Driller. casing <br /> height: <br /> Consultanti —ev <br /> _--- TGeologist <br /> ABOVE-GROUND CHRtM48OX <br /> COWLLMON COMPLETION <br /> EPACIAL PERMIT INFO, Orvord 5WWO <br /> Distance to sewer line <br /> Domestic well on site - (y/n <br /> If yes, location and distance - <br /> tt. <br /> SAMPLING dorsi _ 2 <br /> t*dCn <br /> Holding Temperature — <br /> Method <br /> Screening Method <br /> =_ <br /> Tracking Sheet - {y/ n) x' = <br /> _eft. <br /> ft. <br /> SPOILS <br /> Storage Method {VIATERIAGS/DEVEI.OPMENT <br /> Contamination Noted- {y/n) <br /> Storage Location Casing type <br /> Blank—ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block. - (y/n } <br /> Quantity Installed Discussed with geologist: - (y/ n} <br /> Type of method <br /> EH 29 29 <br />